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General Surgery / Endocrine Surgery

American Hospital Dubai is now offering a new, minimally invasive procedure to treat selected patients with hyperparathyroidism. This disorder, which affects the parathyroid glands, can deplete the bones of calcium, and often cause fatigue as well as kidney stones.
 
The body has four parathyroid glands located behind the thyroid gland. These glands produce hormones that regulate the body’s calcium levels. Not uncommonly, one or more glands can become enlarged and secrete excess hormone resulting potentially in the symptoms noted above. Unfortunately, many people don’t realize they have the disorder because it is often confused with other common medical conditions including depression, osteoporosis, kidney stones, hypertension, and peptic ulcer disease, all of which can be caused by hyperparathyroidism.
 
The diagnosis of hyperparathyroidism is made by a simple blood test that checks for elevated calcium and parathormone levels. In places where calcium levels are checked in routine screening bloodwork, the disease is often found before any symptoms develop. Once the patient is diagnosed with the disorder, a nuclear medicine scan can be performed to determine if it is secondary to one gland disease, as is the case in 85% of cases. These are the patients that are candidates for a minimally invasive procedure, which generally can be performed on an outpatient basis with excellent results.
 
The actual procedure is performed by injecting a small, safe dose of radioactive dye which is concentrated by the parathyroid tumor.  Surgeons can then use a miniature handheld probe in the operating room to detect and remove the tumor. Blood work can be checked within 15 minutes post excision of the tumor to assure that the patient is cured of their disease since the parathormone level returns to normal within minutes.
 
Recently at American Hospital Dubai, a 65-yr old male was evaluated due to multiple kidney stones. He indeed had an elevated calcium and a parathormone level which was quite elevated at 14.1 (normal 1.6-6.9). His sestamibi scan (Figure A) revealed the adenoma to be in the right inferior position. This was removed by using the above described minimally invasive approach with the immediate post operative parathormone assay result dropping to 2.7 thus confirming that the patient was surgically cured. The patient went home on same day feeling quite well.
 
This minimally invasive, outpatient procedure also offers a much lower complication rate, in contrast to the traditional surgery which involves making a larger incision across both sides of the neck to visualize all four glands, which is now only required in those with multiple gland disease. The traditional procedure may result in hospitalization for several days and prolonged hypoparathyroidism with a need for long term calcium supplementation.
 
Anyone with a history of kidney stones, premature bone loss, or excess fatigue should certainly have their calcium levels in the blood checked. If the calcium level is elevated, then a parathormone level is the next appropriate test to determine if the patient has hyperparathyroidism. Surgery, remains the only curative option, but now can be performed with minimal risk as an outpatient procedure.

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